Revisiting the Thyroid Thing: The Results

Before you get too far into this, into a blog entry posted on a Web site called Diabetes Self-Management, please know that what follows has little to do with diabetes.

You may recall that two weeks ago I had a thyroid ultrasound (see both “Is It Just Always Something?” and “No Food or Drink Allowed”). That day, I was going to report on the experience of the ultrasound, but then the infamous “Don’t drink the fruit juice in here” incident came up, and I was compelled to share with you what I considered a diabetic slight.

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But, the thyroid biopsy was itself rather uneventful. The nurse led me down one corridor, then past another waiting room, and then we turned and walked down a few more hallways before going into a rather large room in which I would have the biopsy performed.

When I thought about my biopsy prior to actually being in the hospital, I imagined that it would be a simple “lie back, we’re going to poke you a few times,” and then everything would be over. Instead, it was more like being present for a minor surgery, which it was.

Minor surgery is a vague term, I know. To me, surgery is the whole operating theater, see-it-on-TV drama, with blood and guts and beeping and machine noise, and lots of people standing around the operating table. For my biopsy, the minor surgical aspect was just that: a nurse, a doctor doing the biopsy, and an ultrasound representative (or some sort of someone like that; it was a new ultrasound interface, so this person was there to help the doctor navigate its new features).

The procedure came complete with my having to read and sign a consent form (“I’ll leave the room so you can read this and not feel pressured to sign”); sterile fields (“don’t bring your hands up into this area”); a good dollop and rub of cold iodine(ish) fluid to prep my skin; lots of “nurse I need a new set of gloves because I just touched…” (a) “the table,” or (b) “the cord,” or (c) “the screen,” or (d) “my gown”; as well as my being able to look over at the ultrasound screen and see the cystic mass that has grown on my thyroid, see the needles (six of them in total) going two inches into my neck, one by one, and then watching them move back and forth while the doctor palpated — kind of bounced the needle up and down — in and around the mass to get the fluid out for sampling, all the while my head experiencing this weird throbbing because my body was trying to interpret, but couldn’t, what was going on in my throat.

The treatment I received throughout this minor surgery was phenomenal, from my interaction with the nurse to the thoroughness of the doctor’s explanations of procedures and then his explanation of what he was doing as he performed the actual biopsy.

After the biopsy, the doctor then spent five minutes explaining the possible different results that I might receive when, in three to five business days, my doctor would have contacted me. There was, of course, the possibility of the diagnosis of cancer. Then there was its opposite diagnosis: no cancer.

And then…then there was this gray area, something called suboptimal, which he quickly prefaced by saying, “Don’t let this scare you” before proceeding to tell me about what suboptimal meant.

Guess which result came back?

Suboptimal.

So, yeah.

Inconclusive.

However…

Suboptimal diagnoses on thyroid biopsies are — if you ask me — pretty good news, all things considered.

Allow me to paraphrase some things from my doctor in what follows, as well as adding my own (and yeah, you won’t know exactly what text is mine and what’s hers, and I want it that way).

The good news is that the biopsy did not show any evidence of cancer cells. There was a mixture of Hurthle cells, follicular cells, and colloid cells (you can do your own Googling of these types of cells if you’re curious).

The not-quite-so-good news: The sample was, as I said, considered “suboptimal.” This means that the sample wasn’t adequate to make a definitive diagnosis, but this can be typical of lesions with a cystic component, which mine was.

Lesions with a cystic component inherently have a lower risk of being something bad (read cancerous).

All in all, I’m satisfied. For now. I was prepared for this diagnosis, thanks to the doctor (the one who performed the biopsy) taking his time to explain this possibility to me the day of the biopsy. He even referred to a study that the University of Michigan Hospital conducted on over 500 patients with suboptimal returns on their thyroid biopsies. Over time, only 2% of those receiving suboptimal diagnoses developed cancer; and of those, the cancer that developed was the — and I forget the word he used for it here, so I’ll put in my own words — best kind to get…the type that’s easily and completely treatable.

What do I do now, then?

I have another thyroid ultrasound in six months (I’m already having a repeat ultrasound next year on my kidney for what they — doctors, again — want to confirm with the follow-up). Then, after the six-month thyroid ultrasound, follow-up ultrasounds every year.

Ultrasounds aplenty!

This damned human body and its so many shades of gray. You’d think that with scientists and the billions of dollars that go toward figuring us out, there’d be something more conclusive. But no.

Ah, well. As is more-than-oft repeated in Vonnegut’s Slaughterhouse-Five, “So it goes…”

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suzanne_una

I had similar with my first biopsy. My doc said we’d look at it again in six months via ultrasound and we did. She didn’t want me to go through the biopsy procedure again if I didn’t have to but she was worried about one little place where she didn’t get enough cells the first time. So I told her “let’s just do it again. You will feel better and then I will feel better.” She was surprised but glad I felt that way. End result, got the second procedure, waited on the results, everything is OK.

CalgaryDiabetic

Dear Eric.

I wonder if this is a case of too much medical technology. No wonder the US has the highest health care cost in the world and not always the best outcomes.

My friend, who is healthy like a horse and will live to 90 as long as he stays away from doctors, whent for a private clinic NMR scan and they gave him a list of potential problems.

With diabetes we have enough real problems without being stressed out about potential ones.

vie

Eric,It is good you had a Doctor that talked to you. Many years ago. (40) I had a Doctor tell me one Thyroid gland was twice the size of the other. The next thing I know I am under a machine that was going back and forth over my head and neck. I had to drink something(?) I found out only recently that it was a radiation treatment and he dissolved my thyroid gland. For over 40 years I have battled weight. Every Doctor I went to I told them about the thyroid to be told my test were normal.. (tsh) It was not until 2 years ago as collapsed at work and spent 2 days in hospital that my Heart Doctor found my thyroid problem.Since then I have found a good website stopthethyroidmadness.com I was crying because now I knew why i always felt so bad so much. I have had to spend a lot of time finding a doctor that will run other test. Why do we have to force them todo their jobs? My diabetic doctor got upset when she found out my heart doctor found the thyroid problem. I had to leave her. It is my life I am 66 and have been fighting this for so long. What would have it hurt for her to run the other 2 test T-3 T-4? .Best Of luck to you.

mskitty4

I understand your anxiety about your thyroid. I had them too. Diagnosed overactive in 1999, i looked like a canditate fm a German concentration camp, but ate like a linebacker at a buffet table.Some low key treatments were tried but I have an agressive metabolism. Finally decided on irradiation to handle the excess thyroid hormone coursing through my body. Also did it to prevent heart damage from beeating too fast. Sounded like a steady tom-tom beat.my thyroid was irradiated a 2nd time because my TSH tests were in flux. In 2007, my overactive, cotrolled thyroid slipped over the border to underactive thyroid (my current condition).

What I dont’ understand, vie, why your doctor didn’t tell you about the irration, and why she didn’t ask you to take a Panel 7 test which include the TSH test (for thyroid levels)?

dgeffner

I was pleased to see thyroid problems mentioned on this diabetes blog. There is a relationship of both hyper and hypothyroidism with both type 1 and type 2 diabetes. About 30% of patients I see in the Gonda Diabetes Center at UCLA have concomitant thyroid problems. This is both age and sex related. It is amazing how many of my patients with diabetes also have a family history of thyroid disease (goiters or operations on the neck) as well as visa versa for my thyroid patients.
Most learned societies now recommend a screening test, serum TSH, yearly for patients with diabetes.

For those of you that have thyroid nodules and a fine needle aspiration (FNA) is suggested, it really is no big deal. I started doing them 35 years ago under sterile conditions – but now we do not bother. I glove up (to protect myself, not you) and use a little alcohol. I numb the area with a little plain xylocaine (Novocaine) with a very fine needle (just like the needles you use to inject insulin) subcutaneously, then make a few passes with a 21 gauge needle (just like the needle used to draw blood for tests). The whole procedure takes under 5 minutes.

Two other modifications have occurred over 53 years: Many FNAs are done under ultrasound and physicians have learned to stain before you leave the office to check that the specimens are adequate to be sent to the pathologists for definitive readings.

There are many crazy thyroid web sites. I give patients a sheet with the web sites of the Endocrine Society, Hormone Foundation, AACE, and the American Thyroid Association.

Janice

I have always been fatigued, my primary doctor almost let my diabetes go undianosed due to him not reading “my complaints” I handed to him requesting a diabetes test, in Sept. 2007, I was diagnosed after breaking my wrist and my blood sugar was over 400 and still no one told me I was diabetic. Until the primary doctor finally in May of 2008 ran a blood sugar test and told me to come back after fasting and it was over 200 as before.
Now….to the thyroid…..does thyroid disease go hand in hand with diabetes? Or is it just another illness, we have to deal with? I had begged him to do the thyroid hormone test several times, even a doctor that had to change my depression medicine, told me to inform my doctor to keep a watch on it….to no avail…until recently. I had one done and it was 5.8, don’t ask me if it was + or – I don’t know….but he did say he wanted another done on me because it should have been over an 8……when the other doctor said on a scale of xyz, can’t remember exactly, but if it differed one number I was to be treated for thyroid disease.

I am 64 now, but when I was in my 20’s, I was told I had low thyroid and was put on medication, I couldn’t tell any difference so I stopped taking the medicine. However, two of my older sisters have been on thyroid medication for years and they are both in their 70’s.

Does thyroid disease run in families? I have a niece that has Graves Disease, I think that is what it is called, and they eradicated her thyroid glands. (I think)

I have all the systems of low thyroid, but I had systems of diabetes before I ever had high blood sugar counts…I also have Fibromyalgia and it mimicks over 40 different diseases. So when anything strikes me, is it real or is it Fibromyalgia??????? If you don’t ever have this thank your lucky stars…it only makes everything 10 x worse and the pain gets to the sucidial level if it is not treated before it starts.

Thanks for letting me get some of my complaints out. LOL

Janice

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